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• W2779301024 abstract "To the Editor: Striae distensae frequently lead to psychologic distress for patients1Al-Himdani S. Ud-Din S. Gilmore S. Bayat A. Striae distensae: a comprehensive review and evidence-based evaluation of prophylaxis and treatment.Br J Dermatol. 2014; 170: 527-547Crossref PubMed Scopus (111) Google Scholar and occur in 70% of females, 40% of adolescent males, and 90% of pregnant women,2Goldberg J.D. Marmur E.S. Schmults C. Hussain M. Phelps R. Histologic and ultraestrutural analysis of ultraviolet B laser and light source treatment of leukoderma in striae distensae.Dermatol Surg. 2005; 31: 385-387Crossref PubMed Scopus (45) Google Scholar who usually develop striae gravidarum (SG) during the last trimester of pregnancy.3Henry F. Piérard-Franchimont C. Pans A. Piérard G.E. Striae distensae of pregnancy. An in vivo biomechanical evaluation.Int J Dermatol. 1997; 36: 506-508Crossref PubMed Scopus (35) Google Scholar Younger age, maternal and family history of SG, increased prepregnancy and predelivery weight of the mother, and increased birth weight of the baby are the most significant risk factors identified for SG.4Farahnik B. Park K. Kroumpouzos G. Murase J. Striae gravidarum: risk factors, prevention, and management.Int J Womens Dermatol. 2016; 3: 77-85Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar Despite the widespread use of ablative lasers, SG have not been clinically and histologically studied after carbon dioxide (CO2) fractional system treatment. Improved understanding of histopathologic changes may lead to new treatment insights. We performed a single-center, 2-arm, prospective, self-control open label study. A total of 13 female volunteers with SG who were recruited after signing the informed consent form (institutional ethics committee approval 323/2009) received the treatment on the right side of their abdominal region with a 70-W ablative 10,600-nm CO2 fractional single-pass, nonoverlapping laser (CO2FS, Pixel-CO2, Alma Lasers, Cesarea, Israel). Each patient underwent 4 sessions at increasing pulse energy levels (80, 90, 100, and 110 mJ/microscopic treatment zone) with a 30-day interval between each session. The left half of the abdominal region was kept untreated (Fig 1). The largest pretreatment stria was selected for measurement and skin biopsy before treatment and the same stria was again used 1 month after treatment (4 sessions); patient satisfaction was assessed with a visual scale. Normal-appearing pretreatment skin biopsy specimens were also obtained. The histologic changes were evaluated on the superficial (part A, 500 ± 10 μm) and deep portions (part B, 501-1000 μm) of the skin samples for analysis of collagen fibers (Masson's trichrome and picrosirius red staining) and recent, intermediate, and mature elastic fibers (resorcine fucsine with or without oxone and Verhoeff staining). The thickness of the epidermis was also measured. We observed a significant increase in the amount of collagen fibers (P < .05) in the post-treatment SG samples (with Masson's trichrome: part A, from 36.70 ± 4,94 to 45.58 ± 7,00 μm2, and part B, from 31.08 ± 4.40 to 41.69 ± 10.21 μm2; with picrosirius red: from 17.19 ± 4.77 μm2 to 21.27 ± 5.47 μm2). Additionally, a nonsignificant difference was observed for collagen when untreated normal-appearing skin was compared with post-treatment samples (Table I). A nonsignificant increase in the number of mature intermediate and recent elastic fibers was observed (P > .05). Possible reasons for this are the difference between patient's elastic fiber maturation and the higher thermal stability of elastin in comparison with that of collagen fibers.5Samouillan V. Delaunay F. Dandurand J. et al.The use of thermal techniques for the characterization and selection of natural biomaterials.J Funct Biomater. 2011; 2: 230-248Crossref PubMed Scopus (38) Google ScholarTable ICollagen and elastic fibers quantificationSpecimenNormal- appearing skin,mean ± SDSG before treatment,mean ± SDSG after treatmentmean ± SDP valueNormal-appearing skin × before treatmentBefore treatment × after treatmentNormal-appearing skin × after treatmentCollagen part A (Masson)43.58 ± 11.3536.70 ± 4.9445.58 ± 7.00.075.002.600Collagen part B (Masson)38.89 ± 12.9131.08 ± 4.4041.69 ± 10.21.087.004.701Collagen (picrosirius)26.22 ± 6.6017.19 ± 4.7721.27 ± 5.47.001.023.033Recent elastic fibers (RF with oxone)0.061 ± 0.0140.033 ± 0.0170.038 ± 0.022.008.657.026Intermediate elastic fibers - (RF)0.034 ± 0.0090.020 ± 0.0100.025 ± 0.015.016.286.075Mature elastic fibers – Part A (Verhoeff)2.67 ± 1.893.45 ± 3.153.80 ± 2.63.701.463.422Mature elastic fibers – Part B (Verhoeff)6.91 ± 5.076.56 ± 6.067.51 ± 3.61.175.463.384Description of the averages of fiber percentages found in the streak specimens in their respective staining, with the differences found through the Wilcoxon test. The measurements were performed in μm2 and the data expressed in proportional area of fibers in relation to the selected area in the slice (%).RF, Resorcine fucsine; SD, standard deviation; SG, striae gravidarum. Open table in a new tab Description of the averages of fiber percentages found in the streak specimens in their respective staining, with the differences found through the Wilcoxon test. The measurements were performed in μm2 and the data expressed in proportional area of fibers in relation to the selected area in the slice (%). RF, Resorcine fucsine; SD, standard deviation; SG, striae gravidarum. Also, a significant increase was observed in the thickness of the epidermal cell layer of the post-treatment samples when compared with normal-appearing skin (normal-appearing skin, 67.08 ± 11.55 μm; before treatment, 77.55 ± 17.19 μm; and after treatment, 90.67 ± 18.17 μm; [P < .05]). Of the 13 patients, 12 considered their results to be good or very good 30 days after the treatment. The clinical improvement was evidenced by a significant decrease (P < .05) in the width of the largest stria measured before (0.66 ± 0.32 cm) and after treatment (0.43 ± 0.23 cm). As expected, erythema, swelling, and scale formation were observed in all the patients, with no further complications." @default.
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• W2779301024 title "Fractional ablative carbon-dioxide laser treatment improves histologic and clinical aspects of striae gravidarum: A prospective open label paired study" @default.
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